Travis asks, “Same patient as above. Had two ectopic pregnancies and one miscarriage, and she was trying to get pregnant. Currently waiting DUTCH Cycle Map lab results but suspected estrogen-dominant. DHEA, testosterone sex hormone, binding globulin are super optimal. She has hypothyroidism, stage I, with elevated TSH and suboptimal T3. If she wants to get pregnant, where do we start?”
Chris: Well, certainly normalizing B12 is hugely important, especially with the desire to get pregnant. I think injection could make sense there or definitely getting her start on a higher dose sublingual B12. I think you did the right thing in ordering the DUTCH Cycle Map lab results, but I would for sure focus on the B12, and then I would also normalize the thyroid. None of the other hormones will work well if she’s hypothyroid. Hypothyroidism presents a number of risks for both the mom and developing baby during pregnancy. It just makes it harder to get pregnant in the first place, so I would address that. I mean, you also want to think about why she’s hypothyroid. Is it autoimmunity, which is statistically speaking the most common cause or is it iodine deficiency? We’re going to be covering later in the course these issues in more detail how to screen for iodine deficiency. If you test your antibodies to see if she has Hashimoto’s, then you might want to take some steps to kind of balance and regulate her immune system as that will be helpful in the process of her becoming pregnant. Then you want to look at her gut to see if there’s anything going on there that is triggering immune dysfunction and might be also contributing to a hormone imbalance.